


Frontotemporal dementia for the Teen Wolf fan(fic writer)

by chi1013



Category: Teen Wolf (TV)
Genre: Frontotemporal Dementia, I did the research for you, I'm not kidding, Please read this first before writing people!, all you needed to know, how to, information, speech language pathology, this is NOT a fic, this is a primer
Language: English
Status: Completed
Published: 2014-02-14
Updated: 2014-02-14
Packaged: 2018-01-12 10:03:07
Rating: Not Rated
Warnings: No Archive Warnings Apply
Chapters: 1
Words: 2,600
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/1184929
Author URL: https://archiveofourown.org/users/chi1013/pseuds/chi1013
Summary: <blockquote class="userstuff">
              <p>all you ever wanted to know about frontotemporal dementia for your writing and nerdy needs.</p>
            </blockquote>





	Frontotemporal dementia for the Teen Wolf fan(fic writer)

**Author's Note:**

> Sorry for the formatting. i had colors and everything but I couldn't figure out how to get that to crossover. So I went with italics. Also thanks HilaryParker54 and notenuffcaffeine for beta reading to make sure it wasn't too medical and for encouraging me to post.

Dear fanfic writers, This is a post about frontotemporal dementia or FTD. It’s designed to give you information about prevalence (how often it occurs), onset, symptoms, treatment, comorbidities (what occurs with FTD) and anything else you need.

Before I start, I just want to give you a little background about me. I am a Speech Language Pathologist, working primarily with adults in a medical and nursing home setting. As a SLP, I work with adults who have aphasia (acquired language disorders), cognitive deficits, speech deficits, voice deficits, dysphagia (difficulty swallowing) as well as other issues. I’ve worked with a range of cases from stroke to dementia to TBI (traumatic brain injury) to tracheostomies and it seems like everything in between. So when dear Jeff decided to have Claudia Stiliniski be diagnosed with Frontotemporal Dementia, my ears perked up. 

If you have any questions not answered here, please feel free to contact me and I’ll do my best to answer. If you have any general speech and language questions, I’ll do what I can as well.

My own experience with FTD is limited however there is a growing body of evidence based literature coming out as it’s becoming a bit of a hot new topic. All of my information will be referenced from websites (and papers if any), that I get. Most likely I’ll be cutting and pasting and explaining any medical terminology in a different color. So, here we go! Good luck. Sorry this is so long.

Italics is me, black is reference information

_(Quick brain anatomy lesson. From “Neuroscience: For the Study of Communicative Disorders, 2nd edition”. by Subhash C Bhatnagar. There are 2 frontal lobes, the right and the left, located, you guessed it, at the front of the brain where your forehead is. Here the primary motor cortex lies kinda in the frontal lobe which basically controls our motor actions. Also our prefrontal cortex is here which controls our cognitive functions including reasoning, abstract thinking, self-monitoring, decision making, planning, and pragmatic behaviors (if you really wanna know more details, email me. or look it up. This is already gonna be long). If you get damage to the prefrontal cortex, you will see someone act impulsive, uninhibited, apathetic, lazy, or confused. We usually say they have no filter anymore. This kind of lesion can really change a person’s personality. Broca’s area is also located in the frontal lobe near the motor cortex. This is 1 of 2 HUGE language areas._

_The temporal lobes are super important for speech. Found below the frontal and parietal lobes, it’s more the bottom of the brain. Usually found on the left side of the brain is our speech center, Wernicke’s area. a stroke here usually will give a person “empty” speech. they sound like they’re making sense but when you listen to them, you realize they’re not saying much of anything at all. Sometimes they’re making up words. but they sound fluent. They also usually have difficulty understanding language. Also the memory center is in this area. ))_

From http://www.theaftd.org/frontotemporal-degeneration/ftd-overview:

FTD causes progressive damage to the anterior temporal and/or frontal lobes of the brain. gradual, progressive decline in behavior and/or language that often has a relatively young age at onset (mid-50s to 60s), but has been seen as early as 21 and as late as 80 years.  _((I can attest to this. I've seen/heard it more in midlife.))_. primarily a disease of behavior and language dysfunction,

also: http://www.theaftd.org/frontotemporal-degeneration/diagnosis -  _basically the important parts are:_

Some FTD patients may have only language dysfunction (this is seen in the two types of progressive aphasia: _(progressive aphasia is gradual loss of language)_  semantic dementia  _(difficulty with understanding meaning of words, word finding difficulties)_  and progressive non-fluent aphasia  _(basically loss of speech with any speech attempted as very laborous)_. And the pattern of language loss may be specific, such as an inability to name a familiar, everyday object.

FTD patients are more likely to display early motor abnormalities, such as difficulty walking, rigidity or tremor (similar to Parkinson disease), or muscle atrophy and weakness.  _(this is why I gave you the anatomy lesson. Remember, in the frontal lobe is our motor cortex!)_

Unusual behaviors may include swearing, overeating (especially carbohydrates) or drinking, impulsivity, shoplifting, hypersexual behavior  _(oh Stiles)_  and deterioration in personal hygiene habits. Accompanying this is a decreasing self-awareness: the patient displays little insight into how inappropriate his or her behavior is, and little or no concern for its effect on other people, including family and friends. Patients may also display repetitive, stereotyped behaviors, such as hand clapping, humming the same song over and over, or walking to the same place day after day.  _(we call these repetitive behaviors, perseverative behaviors. You’ll prolly see that term later on)_

In a significant minority of FTD patients, a family history suggests a hereditary condition with an autosomal dominant pattern of inheritance. This means there is a clear pattern of FTD-type diagnoses being passed from parent to child, with virtually every patient having an affected parent and each child of an affected person having a 50% chance to inherit the disorder. -  _so they got that right_

From medscape http://emedicine.medscape.com/article/1135164-overview:

The length of progression varies, from 2 to over 20 years with a mean course of 8 years from the onset of symptoms. FTD itself is not life-threatening. It does, however, predispose patients to serious complications such as pneumonia, infection, or injury from a fall. The most common cause of death is pneumonia. -  _huh. makes sense. must have been a complication that killed Claudia. I get more into this further down_

http://www.brain.northwestern.edu/dementia/ppa/

_In north america, it's interchangibly known as primary progressive aphasia (PPA) which has been another hot topic in the SLP world. More about PPA._

PPA begins very gradually and initially is experienced as difficulty thinking of common words while speaking or writing. PPA progressively worsens to the point where verbal communication by any means is very difficult. The ability to understand what others are saying or what is being read also declines. In the early stages, memory, reasoning and visual perception are not affected by the disease and so individuals with PPA are able to function normally in many routine daily living activities despite the aphasia. However, as the illness progresses, other mental abilities also decline. -  _Right. I'd expect verbal language to go first rather than reading/writing which is what stiles had going on. lending more credence to the dreaming aspect._

Back to http://www.theaftd.org/frontotemporal-degeneration/ftd-overview:

Among patients presenting with dementia who are younger than 65 years, the prevalence may be similar to or greater than that of Alzheimer disease.  _This is why it's getting more talk in the SLP world, because it's actually being diagnosed and people are getting treated for it._

Most patients with FTD present in their 50s or 60s. In the review by Westbury and Bub, the mean age of onset was 59 years; the modal age was 64 years.  _I think they literally found the 1 mention of someone in their 20s getting it and went with that. Even Claudia would have been very young for someone diagnosed with FTD. The mean progression is about 8 years so she would have had this for probably a long time. Even if she fully deteriorated in 2 years, people would notice._

_My own thoughts: I think they went with FTD because if it was cancer/tumor, they would HAVE to give stiles the tumor if they wanted to make it look like he was sick like claudia (a red herring). Atrophy, well, that can stop and depending on how much atrophy there is, can be worked around with therapy. You can't reverse atrophy though so I'd be curious what they do there. Also, everyone gets atrophy as they get older. I wouldn't expect it in a 16 year old because male pubescent brains are still maturing unless there really was a dementia or another underlying cause. In fact male brains mature later than female brains, often in mid 20s._

Frontotemporal lobe dementia (FTD), like all dementing illnesses, shortens life expectancy. The exact influence on mortality is unknown, and the rate of disease progression is variable.The literature contains many cases of slowly progressive language dysfunction developing over a period of as long as 10-12 years, without obvious deterioration of other cognitive functions that would justify a diagnosis of dementia. Other patients progress to dementia within a few years - _(Claudia's must have progressed quickly)_

A subset of cases of patients with FTD, motor neuron disease develops. This subgroup of patients has a higher mortality rate from FTD than do other affected patients. Swallowing difficulty and aspiration pneumonia are especially common in this subgroup, but even patients with primary progressive aphasia (PPA) can develop dysphagia _(difficulty swallowing)_ late in the course of the illness. -

_this is more what I'm thinking.. Maybe she developed a motor neuron disorder which could have caused aspiration pna (pneumonia) secondary to dysphagia (aspiration pna is when food particles or liquid enter the lungs and stay there, creating bacteria and therefore, pneumonia). If she did get recurrent aspiration pna and elected not to get a feeding tube, she probably wouldn't have lasted long after that. especially if it got bad enough that she couldn't breathe. If you’re constantly aspirating (quick and “dirty” fact: aspiration is when food/drink enters your lungs. penetration is when it STARTS to go into your airway. So when you choke on water, you probably penetrated...), all the antibiotics in the world won't help you in the end if you never clear the cause of the infection. If she elected to have no feeding tubes inserted (whether short term through the nose or longterm through the stomach), she likely would have kept aspirating or required a speech therapist to assess her swallowing and see if modifications could be made. If she had a living will stating to DNI (do not intubate) and then developed respiratory failure, that would have killed her. If she went DNI/DNR, well, that's the end as well. She may have also had a stroke that killed her. I wonder what the prevalence is between FTD and stroke, if the patient begins to have a higher risk of stroke due to the FTD. Something for me to look up. later._

_In all I’m reading, there is a component of aphasia that occurs with this dementia. Which makes sense because it affects the areas where the speech centers are. In all cases, you progress with word finding/speech first, NOT reading/writing. So we’re looking at a more verbal based problem versus an agraphia (unable to communicate via writing)/alexia (inability to read) to start._

A relatively underappreciated symptom may be a sociopathic one and may first come to light in the context of breaking the law -  _that's interesting..._

_Speech and cognitive examination;_

  * Speech - Many patients have a nonfluent speech pattern, and virtually all have some degree of difficulty in naming or word finding --  _SEE! SEE! verbal language first before written language! Stiles showing none of that. They neglect to write that in anything with stiles' mom. Curious to see if they mention that at all, which they probably won't. I look to you fanfic writers..._
  * Behavior - Behavioral alterations and frontal lobe symptoms have been previously outlined -  _see above..._
  * Ideation - Ideation tends to be concrete, with poor abstraction and organization of responses and delayed shifting of cognitive sets-  _not sure when this develops. Stiles is definitely not showing any of that as he was figuring out those riddles, which is a very abstract task. Basically they start to lose the ability to understand abstract ideas and thoughts and think abstractly. merriam webster defines ideation as : the capacity for or the act of forming or entertaining ideas. so forming abstract ideas (things to do with feelings, complex ideas, feelings etc will be difficult_
  * Visual and spatial functions and constructional tasks – These are much less affected, except as influenced by behavioral and organizational difficulties; motor skills usually are spared, except for perseverative  _(meaning repetitious task. For instance getting stuck on cleaning one spot of the table only or saying the same word over and over)_  or inattentive responses and difficulty with temporal sequencing of tasks _(sequencing a task in the right order.  Like brushing your teeth.  seems simple, right?  For someone with difficuly sequencing, they may put the toothbrush in their mouth dry.  they may brush their teeth then put the toothpaste on.  or start to get the task done then forget what they were doing.  Imagine trying to put on clothes!  For claudia, she may forget to put on her undergarments.  maybe put on her top but not change her pj pants.  She may put on her sweater then her shirt.  everything is out of order.)_
  * Specific ideomotor apraxia - Rare --  _Apraxia is a speech disorder that basically slurs your speech and makes it very difficult to understand. The tongue and lips don’t work right. there may be islands of clear speech interspersed with garbled speech._
  * Memory - Memory is usually preserved for orientation, although information retrieval may be difficult.



_Summary of things:_

3 of the following 6 clinically discriminating features indicate possible behavioral variant FTD (bvFTD):

  * Disinhibition
  * Apathy/inertia
  * Loss of sympathy/empathy
  * Perservative/compulsive behaviors
  * Hyperorality -  _A condition characterized by insertion of inappropriate objects in the mouth. I’m just picturing stiles right now…_.
  * Dysexecutive neuropsychological profile



_If you guys want a great video on FTD from the POV of a spouse and don’t mind crying a bit, watch this video: http://www.youtube.com/watch?v=SA1lcH8zj9I_

_The difference between FTD and alzheimers_ :

http://www.alz.org/dementia/fronto-temporal-dementia-ftd-symptoms.asp

Key Differences Between FTD and Alzheimer's - _Of everything, PLEASE READ THIS.  FTD is NOT Alzheimers.  They are very different diseases with different progressions and symptoms as well as age of onset.  Of everything in here, please remember these 6 bullets._

  * **Age at diagnosis** may be an important clue. Most people with FTD are diagnosed in their 50s and early 60s. Only about 10 percent are diagnosed after age 70. Alzheimer's, on the other hand, grows more common with increasing age.
  * **Memory loss** tends to be a more prominent symptom in early Alzheimer's than in early FTD, although advanced FTD often causes memory loss in addition to its more characteristic effects on behavior and language..
  * **Behavior changes** are often the first noticeable symptoms in bvFTD, the most common form of FTD. Behavior changes are also common as Alzheimer's progresses, but they tend to occur later in the disease.  _(bvFTD stands for behavioral variant FTD) “ takes its greatest toll on personality and behavior. It may begin with subtle changes that may be mistaken for depression. As bvFTD progresses people often develop disinhibition, a striking loss of restraint in personal relations and social life.”_
  * **Problems with spatial orientation** — for example, getting lost in familiar places — are more common in Alzheimer's than in FTD.
  * **Problems with speech**. Although people with Alzheimer's may have trouble thinking of the right word or remembering names, they tend to have less difficulty making sense when they speak, understanding the speech of others, or reading than those with FTD.
  * **Hallucinations and delusions** are relatively common as Alzheimer's progresses, but relatively uncommon in FTD



_So, there’s a lot of information. I kinda just cut and paste and explained as I went. Sorry if it got too medical but that’s a lot of the good information you’re gonna find. Good luck._

 


End file.
